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Objectives Identify key informational and educational items (“messages”) to provide to physicians (general practitioners and specialists) and physiotherapists for the management of pain induced by exercise and mobilization (PIEM). Develop checklists to improve this management in daily practice. Material and methods The Delphi method for consensus-building was used to identify informational and educational messages for health professionals who deal with PIEM. Informed by the results of an extensive qualitative study, a panel of experts from 5 medical and paramedical disciplines concerned with PIEM and a representative of a patients’ association were interviewed individually and iteratively in order to obtain a single, convergent opinion. Results Delphi consultation helped to determine 9 areas corresponding to 54 key messages of information and education for doctors and physiotherapists who deal with PIEM. These messages relate to: defining, characterizing, identifying, and evaluating PIEM; identifying factors that may cause or increase this pain; informing the patient in order to avoid misinterpretation of PIEM; preventing and treating PIEM; and dealing with it during physical therapy sessions. The method also enabled us to develop 2 synthetic instruments (checklists) — 1 for physicians and 1 for physiotherapists — to help with the management of this pain. Conclusion Consulting a panel of experts comprising different categories of actors dealing with PIEM on the basis of a thorough qualitative diagnosis in order to identify messages for a training program makes it possible to harmonize programs with the expectations of patients and the problems encountered by professionals. The formulation of this program and the institutionalization of two checklists should enable health professionals to identify, qualify, and deal more effectively with PIEM. [ABSTRACT FROM AUTHOR]

Cladribine tablets (CLAD) for adult patients with highly active relapsing multiple sclerosis (RMS) have been available in Italy since 2018. We aimed to assess predictors of no-evidence-of-disease-activity-3 (NEDA-3) status after 24 months of the last dose of CLAD. We included 88 patients (70.5% female, mean age at CLAD start 35.4 ± 11.4). Eighteen patients were treatment naïve, 48 switched to CLAD from a First line Disease Modifying Drug (DMD), and 22 from Second line DMDs. All patients were observed for a median follow-up time of 2.4 (1–4) years after the last dose of CLAD. Forty-nine patients (55.7%) showed NEDA at the last available follow-up. Naïve patients (p = 0.001), those with a lower number of previous DMDs (p < 0.001) and, even though not significantly, those switching from first line DMDs (p = 0.069) were more likely NEDA3 at the last available follow-up. In a subgroup of 30 patients (34%), Serum Light Neurofilaments (sNFL) levels showed a decrease from baseline to the 24 months of follow-up, statistically significant from baseline to the sixth month, and from the first to the second year detection. sNFL levels at 12th month showed a strong inverse correlation with the time to NEDA3 loss. Our experience provides information for the 2-years after the last dose of CLAD, confirming a higher effectiveness of CLAD when placed early in the treatment algorithm. Given the ongoing expansion of the therapeutic landscape in MS, sNfL could support individualized decision-making, used as blood-based biomarker for CLAD responses in clinical practice. [Display omitted] • Immune reconstitution therapies might be challenging for their right positioning. • Results obtained from "unselected cohorts" are crucial, as this single centre experience about the 2-years after the last dose of CLAD. • sNfL could support individualized decision-making, used as blood-based biomarker for CLAD responses in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction/Background This study aimed to assess whether the contribution of chronic conditions to disability prevalence varies according to educational attainment and to disentangle the contributions of the prevalence and disabling impact of chronic conditions to educational disparities in the French household population 25 years and older. Material and method Data of the 2009-09 Disability Health Survey were examined ( n = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact. Results In men, the main contributors to the absolute difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart/peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact. Conclusion Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups. [ABSTRACT FROM AUTHOR]

• PMI estimation is still a crucial step in Forensic Pathology. • Morphological and immunohistochemical analysis were performed in gingival tissues. • A gradual degradation of extracellular matrix was detected. • Our combined analyses may allow to better infer the PMI. The estimation of the post mortem interval (PMI) is still one of the most challenging variables to determine and the different approaches currently used in its estimation generally yield to large post mortem windows. In the present study we combined morphological and immunohistochemical analysis in order to reach a more detailed knowledge on tissue organization and degradation after death. Ultrastructural cellular changes and the extracellular matrix of gingival tissues, collected at different post mortem intervals, were observed by a Transmission Electron Microscopy (TEM), in combination with the immunohistochemical detection of extracellular matrix proteins (i.e. collagen type I and collagen type III) as potential post mortem biochemical markers. The final goal was to find a correlation between morphological modifications, biomarkers expression and the time of death. Samples of gingival tissues obtained from 10 cadavers at different post mortem intervals (short post mortem interval, 1–3 days; mid post mortem interval, 4–6 days; long post mortem interval, 7–9 days) were processed for light microscopy and TEM and they were also immunostained with anti-collagen type I and type III antibodies. Results showed gradual degradation of extracellular matrix in the suboral connective tissue in relation to the different time of death. Moreover PMI was related to an increase of nuclear chromatin condensation and cytoplasmic vacuolization both in epithelial and connective tissues. In conclusion, in addition to traditional forensic approaches to estimate PMI, the combined analyses of cellular morphology, ultrastructure and immunohistochemical expression of collagen proteins allow to better infer the PMI. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy and safety of tumor necrosis factor (TNF)-α inhibition with infliximab (IFX) in treating recurrent and disabling chronic sciatica pain associated with post-operative peridural lumbar fibrosis. Methods A double-blind, randomized, placebo controlled study randomized 35 patients presenting sciatica pain associated with post-operative peridural lumbar fibrosis to 2 groups: IFX ( n = 18), a single intravenous injection of 3 mg/kg IFX; and placebo n = 17), a single saline serum injection. The primary outcome was a 50% reduction in sciatica pain on visual analog scale (VAS) at day 10. Secondary outcomes were radicular and lumbar VAS pain at day 0 and radicular and lumbar VAS pain, Québec disability score, drug sparing effect and tolerance at days 10, 30, 90, and 180. Results At day 10, the placebo and IFX groups did not differ in the primary outcome (50% reduction in sciatica pain observed in 3 [17.6%] vs 5 [27.8%] patients, p = 0.69). The number of patients reaching the Patient Acceptable Symptom State for radicular pain was significantly higher in the placebo than IFX group after injection (12 [70.6%] vs 5 [27.8%], p = 0.01). The 2 groups were comparable for all other secondary outcomes. Conclusion Treatment with a single 3-mg/kg IFX injection for post-operative peridural lumbar fibrosis-associated sciatica pain does not significantly reduce radicular symptoms at day 10 after injection. [ABSTRACT FROM AUTHOR]

Introduction/Background/Objective Chronic diseases are the leading cause of mortality and disability worldwide. Exercise therapy has been found effective for mortality, disability and well-being in many chronic conditions. Burden of treatment may reduce patient compliance and treatment efficacy. We aimed to develop and validate a self-reporting questionnaire assessing the burden of exercise therapy for patients with chronic conditions. Material and method We conducted semi-structured interviews with patients to develop items of the questionnaire. The dimensional structure of the questionnaire was assessed by principal component analysis. Construct validity of the instrument was assessed by exploring convergent validity with the Treatment Burden Questionnaire (TBQ) and divergent validity with pain, self-efficacy, treatment satisfaction and health state. Reliability was assessed with the Cronbach alpha coefficient, a test–retest method using the intraclass correlation coefficient (ICC) and Bland-Altman plotting. Results A preliminary list of items was developed from semi-structured interviews with 28 patients and reviewed by two expert physicians. Items obtained were reduced. Then, a sample of 163 patients was used to measure the psychometrics of the Exercise Therapy Burden Questionnaire (ETBQ), consisting of 10 items. Principal component analysis extracted one dimension. The Cronbach alpha was 0.86 [0.82–0.89]. Test–retest reliability ( n = 24 patients) was good, with ICC 0.93 [0.85–0.97], and Bland–Altman analysis did not reveal a systematic trend. The ETBQ showed expected convergent validity with the TBQ (r s = 0.52) and expected divergent validity with pain (r s = 0.37), self-efficacy (r s = −0.34), treatment satisfaction (r s = −0.49) and perceived health state (r s = −0.28). Conclusion The ETBQ is the first questionnaire assessing exercise therapy burden in patients with chronic conditions. Its psychometric properties are promising. [ABSTRACT FROM AUTHOR]

Introduction Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD ≥ 65 years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample. Methods Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age < vs ≥ 65 years, and then divided on the basis of the median age of the sample (age < vs ≥ 42 years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests). Results G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P < .001), showing a significantly later age at onset (29.4 ± 15.1 vs 18.7 ± 9.2 years, P < .001), a more frequent adult onset (75% vs 41.1%, P < .001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P < .05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P = .07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P < .05). Conclusions G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed. [ABSTRACT FROM AUTHOR]

An innovative one-step approach based on femtosecond laser ablation synthesis in aqueous solution is presented for the development of copper nanoparticle-chitosan (CuNP-CS) nano-antimicrobials. The influence of the CS concentration has been assessed, in order to tune the morphological and chemical features of the as-prepared nanomaterial. CuNP-CS hybrid nanocolloids have been characterized by TEM and XPS techniques. Ultrafine and almost monodisperse CuNPs are obtained at a CS concentration of 1 g/L. [ABSTRACT FROM AUTHOR]

The article focuses on development of atool to assist patient during home rehabilitation program and real time monitoring of spine movement. Topics discussed include quantitative assessment of spine curvature two-dimensional images acquired by radiography (X-ray,) three-dimensional (3D) imaging techniques such as tomography and magnetic resonance; and providing visual feedback through a graphic interface to users.

The article discusses low cost system for real time monitoring of spine movement. It mentions regular spine deviations from the natural curvature ‘S shape' cause structural deformity of the spine and back pain which are associated with disability and high costs for health care. It also discusses introduction of a tool to assist patient during home rehabilitation program and provide visual feedback on spinal movements.

The article focuses on the use of steroid injections for patients with low back pain and problems of patients with chronic low back pain have magnetic resonance imaging (MRI) that shows areas of local inflammation around their vertebral discs. It mentions injection of corticosteroids into the area of active discopathy reduces low back pain. It also mentions corticosteroid injection provided short-term relief of chronic low back pain associated with active discopathy.